CAJ | 학술논문

目的：研究储氧面罩吸氧在院前低张性低氧血症救治中的临床价值。方法将82例院前低张性低氧血症患者（轻度52例，中度22例，重度8例）按随机数字表法分为对照组和观察组，每组41例。所有病例均在院前进行救治，常规给予心电、血压、呼吸、动脉血氧饱和度（SaO2）监测，同时快速建立静脉通道。对照组和观察组患者分别佩带普通面罩和储氧面罩，均给予8～10 L·min-1高流量氧气吸入，常规湿化。观察2组患者在吸氧15、30 min时 SaO2变化及加用便携式呼吸机正压通气的例数。结果2组患者随吸氧时间的增加 SaO2均有不同程度的提升。观察组轻、中度患者吸氧15、30 min时 SaO2均明显高于对照组（均P＜0．01）；2组重度低张性低氧血症患者给予高流量氧气吸入15 min时 SaO2比较差异无统计学意义（t＝-1．414，P＞0．05）；高流量氧气吸入30 min时，观察组 SaO2明显高于对照组（t＝-9．000，P＜0．01）。对照组中加用便携式呼吸机正压通气患者6例（重度4例，中度2例），观察组仅1例（重度）加用便携式呼吸机正压通气，2组比较差异有统计学意义（χ2＝3．905，P＜0．05）。结论对于轻、中度低张性低氧血症患者，单一使用储氧面罩吸氧能较快提升 SaO2，迅速纠正机体缺氧状态，在院前急救中具有极高的临床价值。对于重度低张性低氧血症患者，在增加吸氧时间的同时，应充分评估机体缺氧严重程度和院前转运路程的远近，在此基础上，可酌情使用便携式呼吸机正压通气，以降低院前急救风险。
목적：연구저양면조흡양재원전저장성저양혈증구치중적림상개치。방법장82례원전저장성저양혈증환자（경도52례，중도22례，중도8례）안수궤수자표법분위대조조화관찰조，매조41례。소유병례균재원전진행구치，상규급여심전、혈압、호흡、동맥혈양포화도（SaO2）감측，동시쾌속건립정맥통도。대조조화관찰조환자분별패대보통면조화저양면조，균급여8～10 L·min-1고류량양기흡입，상규습화。관찰2조환자재흡양15、30 min시 SaO2변화급가용편휴식호흡궤정압통기적례수。결과2조환자수흡양시간적증가 SaO2균유불동정도적제승。관찰조경、중도환자흡양15、30 min시 SaO2균명현고우대조조（균P＜0．01）；2조중도저장성저양혈증환자급여고류량양기흡입15 min시 SaO2비교차이무통계학의의（t＝-1．414，P＞0．05）；고류량양기흡입30 min시，관찰조 SaO2명현고우대조조（t＝-9．000，P＜0．01）。대조조중가용편휴식호흡궤정압통기환자6례（중도4례，중도2례），관찰조부1례（중도）가용편휴식호흡궤정압통기，2조비교차이유통계학의의（χ2＝3．905，P＜0．05）。결론대우경、중도저장성저양혈증환자，단일사용저양면조흡양능교쾌제승 SaO2，신속규정궤체결양상태，재원전급구중구유겁고적림상개치。대우중도저장성저양혈증환자，재증가흡양시간적동시，응충분평고궤체결양엄중정도화원전전운로정적원근，재차기출상，가작정사용편휴식호흡궤정압통기，이강저원전급구풍험。
Objective To study the clinical value of oxygen inhalation via face mask in the treatment of prehospital hypotonic hypoxemia.Methods Eighty-two patients with prehospital hypotonic hypoxemia(mild in 52,moderate in 22 and severe in 8)were randomly divided into two groups,with 41 patients in each group.All patients received prehospital treatment.Furthermore, electrocardiography,blood pressure,respiration rate and arterial oxygen saturation(SaO2 )were monitored and intravenous access was quickly established.The control group and observation group were given high flow oxygen(8-10 L·min-1 )through ordinary face mask and oxygen stor-age mask,respectively.Changes in SaO2 were observed after oxygen inhalation for 15 and 30 mi-nutes,respectively.In addition,the number of patients who used portable ventilator for positive pressure ventilation was recorded.Results SaO2 increased with oxygen inhalation time in both groups.Compared with control group,SaO2 significantly increased after oxygen inhalation for 1 5 and 30 minutes in mild or moderate hypotonic hypoxemia group(P<0.01).No significant differ-ences in SaO2 in patiens with severe hypotonic hypoxemia were found between control group and observation group after oxygen inhalation for 15 minutes(t=-1.414,P>0.05).However,SaO2 in severe hypotonic hypoxemia group was significantly higher than that in control group after ox-ygen inhalation for 30 minutes(t=-9.000,P<0.01).The number of patients who used portable ventilator for positive pressure ventilation in control group(6 patients,moderate in 2 and severe in 4)was significantly higher than that in observation group(1 severe patients)(χ2=3.905,P<0.05).Conclusion For patients with mild or moderate hypotonic hypoxemia,the use of oxygen storage mask alone can quickly increase SaO2 and correct hypoxia status,with a high clinical value in the prehospital treatment.For patients with severe hypotonic hypoxemia,the duration of oxy-gen inhalation should be increased.At the same time,the severity of hypoxia and distance of pre-hospital transport should be fully assessed.On this basis,the portable ventilator may be appropri-ately used for positive pressure ventilation to reduce the risk of pre-hospital first aid.